Provider Demographics
NPI:1730215054
Name:SINHA, POLLY BHATTACHARYYA (PT)
Entity type:Individual
Prefix:MRS
First Name:POLLY
Middle Name:BHATTACHARYYA
Last Name:SINHA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 FORTUNE BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7474
Mailing Address - Country:US
Mailing Address - Phone:618-607-0061
Mailing Address - Fax:
Practice Address - Street 1:1191 FORTUNE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-7474
Practice Address - Country:US
Practice Address - Phone:618-607-0061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070022977225100000X
WAPT60294943225100000X
MO2021010596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist